自发性孤立性肠系膜上动脉夹层的诊治

Spontaneous isolated superior mesenteric artery dissection: Diagnosis and treatment

摘要:

目的：探讨自发性孤立性肠系膜上动脉夹层（spontaneous isolated superior mesenteric artery dissection，SISMAD）的临床特点和诊治方法。
方法：回顾性分析2006年1月—2010年3月收治的9例自发性孤立性肠系膜上动脉夹层的临床资料，其中8例表现为急性腹痛，1例无症状。
结果：2例保守治疗，4例行腔内自膨式支架植入，3例手术治疗（1例行腹主动脉-肠系膜上动脉转流术，2例行内膜修补、人造血管补片成形术）。8例有症状者，腹痛均在治疗后3 d内完全缓解。本组病例随访1个月至51个月，未再出现腹部不适症状，增强CT显示肠系膜上动脉血流通畅，未见明显瘤样扩张。
结论：对有SISMAD可能的患者应警惕，及早诊断和处理，根据患者具体情况选择合理的治疗方案。

Abstract:

Objective：To investigate the clinical features, diagnosis and treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD).
Methods：The clinical data of 9 cases of SISMAD admitted in our hospital between January 2006 and March 2010 were retrospectively analyzed. Acute abdominal pain occurred in 8 cases and one case was symptomless. 
Results：Conservative treatments were performed in 2 cases and interventional self-expanding stents were implanted in 4 cases; and operation was performed on 3 cases, in one of them, an aortomesenteric bypass was done, and the other 2 cases underwent endarterectomy and patch plasty of superior mensenteric artery. Eight cases recovered satisfactorily from the procedure with resolution of the abdominal pain in 3 days postoperatively.  One month to 51 months of follow-up showed that no recurrence of abdominal discomfort in any of the cases. Contrast-enhanced CT examination showed superior mesenteric arteries were patent and with no marked aneurysmal dilatations. 
Conclusions：One should be vigilant of the potential patients with spontaneous isolated superior mesenteric artery dissection, and institute appropriate management based on the actual condition of the patient.